Fertility and reproductive age

Fertility is unpredictable and is declining with age. Women tend to have their first child in an older age than usual (more than 35 years old). At that time there is a greater risk for miscarriage and the associated medical problems such as diabetes or hypertension. Age affects also older men concerning reproductive capacity.

What we need to understand is the population trend in childbearing and the effect of age on pregnancy. We need also to provide advice to women seeking family planning and explain to people, that In vitro fertilisation (IVF) is not the final solution.

Better counselling to the young partners, to avoid teenage pregnancies, should not compromise the ideal age for reproduction in women between 25 and 30 years old.

What about women who would not like to compromise their carrier with a pregnancy, or did not find the ideal partner or delay pregnancy for socio-economic reasons. Should all these women vitrify eggs in a cryo-bank and the men save sperm for the future?

When women are asked why they delay getting pregnant, 63% express their concern about their carrier, 53% for financial reasons and 53% because they did not find the suitable partner.

A cause for concern is that as the maternal age at the birth of the first child is getting higher and there is also a significant drop in pregnancies per woman.

What are the adverse gynaecological effects of age in female reproduction?

First of all in a small percentage there is a risk of premature menopause (considering that the usual age is 51 years old). The effects of sexually transmitted disease and endometriosis as well as fibroids in size and numbers are increased with age.

Finally many women are having surgery to the neck of the uterus (cervix) because of cervical intraepithelial neoplasia, caused by Human papilloma virus, the most common sexually transmitted disease!

What the adverse medical effects which are age related?

With age there is an increase in blood pressure with a risk of preeclampsia and raised blood sugar with a risk of diabetes

What are the adverse effects of age to the pregnancy?

There is an increased risk of miscarriage, chromosome anomalies, and multiple pregnancies because of age, or in vitro fertilisation. One may also add an increased risk of stillbirth, mal-presentation, prematurity and morbidity.

A good obstetrician should give advice concerning the avoidable factors such as smoking and alcohol. He should treat on time sexually transmitted diseases and perform minimum but necessary surgery, avoiding to the patient any residual adhesions, which may compromise the woman’s fertility in the future.

The obstetrician should also be aware of medical problems and treat them on time, in collaboration with other medical specialists.

As far the pregnancy is concerned, the obstetrician should remain vigilant, using colour Doppler and serial scans to confirm the foetus’s well-being, integrity and growth. Also the presence of a neonatologist (baby Doctor) at birth, is by far required to deal with the unexpected.

Everything should be tailored to everyone needs and there should be careful predictions and interventions for the baby’s benefit and to the happy couple.

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